How research ethics boards are undermining survey research on Canadian university students

In Canada, all research conducted by individuals associated with universities must be subjected to review by research ethics boards (REB). Unfortunately, decisions reached by REBs may seriously compromise the integrity of university-based research. In this paper attention will focus on how requirements of REBs and a legal department in four Canadian universities affected response rates to a survey of domestic and international students. It will be shown that in universities in which students were sent a legalistic cover letter to a mail survey, or were required to sign a consent form, lower response rates were achieved than in universities in which students were sent a relatively friendly letter. In turn, lower response rates resulted in: sample characteristics that deviated from population characteristics; a reduction in the possibility of testing research hypotheses; and increased survey costs. As a consequence, it is argued that the unreasonable demands of REBs are seriously compromising the quality of research that can be carried out on Canadian university students.     

Clinical ethics consultations: reasons for optimism, but problems exist

[The author identifies] five problems familiar to clinical ethicists. (1) Physicians often do not recognize important ethical issues. (2) Debate exists over whether such consultations should give specific management recommendations. (3) Principles of medical ethics cannot, by themselves, resolve real ethical issues. (4) The patient's interests sometimes conflict with the interests of the family, the health professionals, and the hospital. (5) Clinical ethics consultations take a toll on the consultant....[He] discuss[es] the implications of each problem for clinical ethics consultations and offer[s] a solution to it.     

Ill-placed democracy: ethics consultations and the moral status of voting

As groups around the country begin to craft standards for clinical ethics consultations, one focus of that work is the proper procedure for conducting ethics consults. From a recent empirical look into the workings of ethics consult services (ECSs), one worrisome finding is that some ECSs rely on a committee vote when making a recommendation. This article examines the practice of voting and its moral standing as a procedural strategy for arriving at a clinical ethics recommendation. I focus here on the type of clinical ethics conflicts that are most likely to lead an ECS to vote, namely, conflicts involving ethical uncertainty--or, in the Greek, aporia. I argue that in cases of aporia, voting on an ethics conflict is not a morally justifiable procedure. Then on the same grounds that I use to show that voting is ethically problematic, I raise broader concerns about the common practice of making recommendations by other procedures. In contrast to the standard approach of adjudicating between moral claims, I argue that ECSs can best resolve aporetic conflict through the process of clinical ethics mediation.     

Research ethics committees: a regional approach

Guidelines for Institutional Review Boards (IRBs) or research ethics committees exist at national and international levels. These guidelines are based on ethical principles and establish an internationally acceptable standard for the review and conduct of medical research. Having attained a multinational consensus about what these fundamental guidelines should be, IRBs are left to interpret the guidelines and devise their own means of implementing them. Individual and community values bear on the interpretation of the guidelines so different IRBs attain different levels of effectiveness. In the Caribbean and Pan American regions there are few IRBs. Obstacles to the establishment and function of IRBs are exacerbated in developing regions like these by differences in language, literacy, and local value systems; education, administrative expertise, facilities, and access to information are also limited. A regional IRB network might facilitate more uniform ethical review in developing countries, and simplify IRB procedures. This revised version was published online in August 2006 with corrections to the Cover Date.     

Electrophysiology in neuropsychiatric research: a network perspective

A growing number of anatomic and physiologic studies have shown that parallel sensory and motor information processing occurs in multiple cortical areas. These findings challenge the traditional model of brain processing, which states that the brain is a collection of physically discrete processing modules that pass information to each other by neuronal impulses in a stepwise manner. New concepts based on neural network models suggest that the brain is a dynamically shifting collection of interpenetrating, distributed, and transient neural networks. Neither of these models is necessarily mutually exclusive, but each gives different perspectives on the brain that might be complementary. Each model has its own research methodology, with functional magnetic resonance imaging supporting notions of modular processing, and electrophysiology (eg, electroencephalography) emphasizing the network model. These two technologies might be combined fruitfully in the near future to provide us with a better understanding of the brain. However, this common enterprise can succeed only when the inherent limitations and advantages of both models and technologies are known. After a general introduction about electrophysiology as a research tool and its relation to the network model, several practical examples are given on the generation of pathophysiologic models and disease classification, intermediate phenotyping for genetic investigations, and pharmacodynamic modeling. Finally, proposals are made about how to integrate electrophysiology and neuroimaging methods.     

Paradigms in psychosomatic research: a dialectic perspective

By tradition, psychosomatic research has relied on a linear causality model where various psychological and social factors have been correlated to organic disorders. It has become increasingly evident, however, that etiological models based on single causal factors are inadequate. Recently, a reorientation has been noted towards system-oriented multicausality models, which assume that social, psychological, and physiological factors interact in the pathogenesis of a disease. In this review, the limitations and potentials of the linear and system-oriented paradigms are discussed. It is suggested that these perspectives are complementary, and may be applied simultaneously in an integrated, dialectic approach.     

Geography and computer ethics: An Eastern European perspective

Several context-specific social and political factors in Eastern and Central Europe are described — factors that must be considered while developing strategies to introduce Computer Ethics. Poland is used as a primary example. GNP per capita, the cost of hardware and software, uneven and scant distribution of computing resources, and attitudes toward work and authority are discussed. Such “geographical factors” must be taken into account as the new field of Computer Ethics develops.     

Commentary on Fiester's "Ill-placed democracy: ethics consultations and the moral status of voting"

Autumn Fiester identifies an important element in clinical ethics consultation (CEC) that she labels, from the Greek, aporia, "state of perplexity," evidenced in CEC as ethical ambiguity. Fiester argues that the inherent difficulties of cases so characterized render them inappropriate for voting and more amenable to mediation and the search for consensus. This commentary supports Fiester's analysis and adds additional reasons for rejecting voting as a process for resolving disputes in CEC including: it distorts the analysis by empowering individual voters preferences and biases rather than focusing on the interests and wishes of the patient and family; it offers an insufficiently sensitive model for resolving the awesome, nuanced, conflicted, and ethically complex issues surrounding life and death; it marginalizes minority opinions that may have moral validity.